Lymphedema : What is lymphedema and what to expect during your evaluation
What is lymphedema?
Lymphedema is a build-up of lymph fluid in the fatty tissues just under your skin. This build-up might also be called an obstruction and cause swelling/discomfort. It often happens in the arms or legs, but can also happen in the face, neck, trunk, abdomen (belly), and genitals. It's important to know that lymphedema can sometimes become severe and cause serious problems, and often is a long-term or chronic condition. This is why early and careful management is needed to help reduce symptoms and keep it from getting worse.
The lymph (or lymphatic) system is part of your body's immune system. It is a network of lymph nodes, ducts or vessels, and organs that work together to collect and carry clear lymph fluid through the tissues to the blood. What it does:
Maintain fluid balance in the tissue
Part of the immune system- fights infection
Assist in the removal of cellular debris and waste products from the extracellular spaces within tissues
Transport lymph- colorless fluid containing oxygen, proteins, glucose, lymphocytes
There are two main types of lymphedema:
Primary lymphedema – often called congenital lymphedema. The lymphedema is evident at birth or shortly after puberty. This type of lymphedema is rare, affecting approximately 1 in every 6,000 people.
Secondary lymphedema – the lymphedema occurs as a result of something else, such as an infection, injury, trauma, or cancer that affects the lymphatic system.
Lymphedema may be a side effect of cancer treatment, such as radiation therapy or the removal of some lymph nodes, which can damage the lymphatic system. This type of lymphedema is more common.
How did this happen? Possible causes of secondary Lymphedema:
Cancer surgery: Cancer may spread through the body via the lymphatic system. Sometimes surgeons remove lymph nodes to stop the spread. There is a risk the lymphatic system may be affected, leading to lymphedema.
Radiation therapy: The use of radiation to destroy cancerous tissue can sometimes damage nearby healthy tissue, such as the lymphatic system; this can result in lymphedema.
Infections: Severe cellulitis infection may damage tissue around the lymph nodes or vessels. This may lead to scarring, increasing the risk of lymphedema. Some parasite infections can also increase the risk of lymphedema.
Inflammatory conditions: Conditions that cause tissue to swell (become inflamed) may permanently damage the lymphatic system, such as rheumatoid arthritis and eczema.
Cardiovascular diseases: These are diseases that affect blood flow. Some patients with cardiovascular diseases have a higher risk of developing lymphedema, such as DVT(deep vein thrombosis), venous leg ulcers, and varicose veins.
Injury and trauma: More rarely, severe skin burns or anything that results in excessive scarring may raise the risk of developing lymphedema.
You can expect your therapist to do the following at your first appointment:
Your lymphedema therapist will take your cancer history and a complete medical history.
Your therapist also will ask about the symptoms you’ve noticed, such as heaviness, tingling, or swelling, as well as their patterns of onset and triggers.
Your therapist will ask about any pain in the arm, chest, trunk, legs or whatever part of the body is affected — what the pain feels like, how long it lasts, how intense it is.
Your therapist should take a personal history that includes questions about lifestyle and exercise, nutrition, and weight.
Your therapist will look for changes in the skin and soft tissue of the arm, hand, chest, or other area that’s affected.
Your therapist will take circumferential measurements at several points along the hand, wrist, forearm, and upper arm to measure fluid volume. These can
Your therapist may need to rule out other possible causes of the symptoms, such as a recurrence of the cancer, deep vein thrombosis (blood clot), or infection.
Your therapist may order additional tests as needed to aid in diagnosing the lymphedema.
Lymphedema is incurable. However, treatment can help reduce the swelling and pain.
Complex decongestive therapy (CDT): This starts with an intensive therapy phase, during which the patient receives daily treatment and training. This is followed by the maintenance phase when the patient is encouraged to take over their own care using techniques that they have been taught.
The four components of CDT are:
Remedial exercises: These are light exercises aimed at encouraging movement of the lymph fluid out of the limb.
Skincare: Good skincare reduces the risks of skin infections, such as cellulitis.
Manual lymphatic drainage (MLD): The lymphedema therapist uses special massage techniques to move fluid into working lymph nodes, where they are drained. The lymphedema therapist also teaches several massage techniques that can be used during the maintenance phase.
Multilayer lymphedema bandaging (MLLB): Wrapped over muscles surrounding lymph vessels and nodes to help the fluid move through the lymphatic system.
Unlike the circulation of blood, there is no central pump (heart). The aim is to use bandages and compression garments to support the muscles and encourage them to move fluid out of the affected body part. Patients will also be taught how to apply their own bandages and compression garments correctly so that MLLB can continue during the maintenance period.
Together we will develop a treatment plan that meets your needs and suits the kind of lymphedema you have — ranging from mild to moderate to severe. My goal is leave the appointment with a full understanding of your treatment plan.